Reddy Pavan, Chitturi Kalyan R, Merdler Ilan, Zhang Cheng, Cellamare Matteo, Ben-Dor Itsik, Satler Lowell F, Rogers Toby, Weintraub William S, Waksman Ron
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
J Cardiol. 2025 Jun;85(6):494-499. doi: 10.1016/j.jjcc.2024.10.001. Epub 2024 Oct 19.
Among patients with aortic stenosis, ventricular remodeling by hypertrophy can limit the augmentation of flow with exertion, even after valve intervention. However, the effect of hypertrophy on quality of life (QoL) improvement has not been studied. We aimed to determine the effect of ventricular hypertrophy on QoL outcomes after transcatheter aortic valve replacement (TAVR).
All patients undergoing TAVR from 2011 to 2021 at our institution were included. Groups were divided into none/mild ventricular hypertrophy (non-remodeled, NR) and moderate/severe left ventricular hypertrophy (VH) according to guideline-recommended cut-offs for left ventricular (LV) wall thickness. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was utilized to assess QoL; primary outcome was KCCQ change <5 from baseline to 30 days and 1 year.
We analyzed 679 patients (NR: N = 389, VH: N = 290). Groups differed by septal thickness (1.12 cm vs. 1.44 cm, p < 0.001), posterior wall thickness (1.08 cm vs. 1.33 cm, p < 0.001), and LV internal diastolic diameter (4.34 cm vs. 4.19 cm, p = 0.006). The primary outcome was similar between NR and VH at 30 days (31.6 % vs. 28.6 %, p = 0.449) and 1 year (27.7 % vs. 21.5 %, p = 0.217). NR and VH experienced similar proportions of worsening, no change, or small, moderate, and large improvements in KCCQ score. Both groups experienced similar domain score changes and New York Heart Association class improvement. A subgroup analysis of VH patients did not reveal interaction with cavity size or stroke volume.
Patients with significant ventricular remodeling by hypertrophy and aortic stenosis have similar QoL changes after intervention compared to patients without significant remodeling.
在主动脉瓣狭窄患者中，即使在瓣膜干预后，肥厚引起的心室重塑也会限制运动时血流的增加。然而，肥厚对生活质量（QoL）改善的影响尚未得到研究。我们旨在确定经导管主动脉瓣置换术（TAVR）后心室肥厚对生活质量结果的影响。
纳入2011年至2021年在我院接受TAVR的所有患者。根据左心室（LV）壁厚度的指南推荐临界值，将患者分为无/轻度心室肥厚（非重塑，NR）和中度/重度左心室肥厚（VH）两组。采用堪萨斯城心肌病问卷（KCCQ）评估生活质量；主要结局是从基线到30天和1年时KCCQ变化<5。
我们分析了679例患者（NR组：N = 389，VH组：N = 290）。两组在室间隔厚度（1.12 cm对1.44 cm，p < 0.001）、后壁厚度（1.08 cm对1.33 cm，p < 0.001）和左心室内径舒张末期（4.34 cm对4.19 cm，p = 0.006）方面存在差异。NR组和VH组在30天时的主要结局相似（31.6%对28.6%，p = 0.449），在1年时也相似（27.7%对21.5%，p = 0.217）。NR组和VH组在KCCQ评分恶化、无变化或有小、中、大改善的比例相似。两组的领域评分变化和纽约心脏协会心功能分级改善情况相似。对VH患者的亚组分析未发现与腔室大小或每搏输出量的相互作用。
与无明显重塑的患者相比，有明显肥厚性心室重塑和主动脉瓣狭窄的患者在干预后的生活质量变化相似。
